Illinois’s failure to care for mentally-ill children

This article is a summary and response to The Atlantic’s article, “The Kids Who Are Cleared to Leave Psychiatric Hospitals — But Can’t“.

In Illinois, some children in Department of Children and Family Services (DCFS) custody are being held in psychiatric hospitals much longer than medically required. 

mental health scrabble

The goal of psychiatric hospitals is to stabilize children and create treatment plans for outside doctors and centers to follow through on. Once a child is stabilized, they are supposed to be released. These facilities are not meant to handle long-term treatment, but in Illinois, they are increasingly being used to do just that.

DCFS is required to move the children in their care to foster homes or residential treatment centers as quickly as possible, but they have been struggling for years to find placements for children in a reasonable amount of time, so children suffer in these psychiatric hospitals which are not designed for long-term care.

While there are not good statistics available about how states nationwide handle children’s stays in mental health facilities, the data available does suggest other states also have issues relating to placement. However, some have suggested that the situation in Illinois is one of the most pressing in the nation.

Through information received via FOIA requests, it has come to light that between 2015 and 2017, on average, 1 of every 5 days spent in treatment were not medically required. This overstay, which includes about 30% of DCFS’s roughly 6K psychiatric hospitalizations of children in their care, totals about 27K days, or almost 75 years.

Of the more than 800 children who were held past their ability to be released, 80%  were held at least 10 days more than needed, 40% were held at least 1 month, and 15% had to wait at least 2 months, and sometimes significantly longer.

“There was a girl who spent so much time in one [psychiatric hospital] that hospital staff were asked to bring her a winter coat. She had been admitted in the summer.”

These needlessly long hospital stays have a number of negative consequences for children. Children can fall behind in their social development very quickly, and develop severe emotional challenges which make them more difficult to place. They can also lead to educational delays, which can be very difficult. Children receive infrequent visits from teachers during their stay, and while some have an hour or two of instruction per day, many receive less. The school work they do often consist only of worksheets. In some cases, children are hospitalized so long past when they were eligible for discharge that they are forced to repeat grades in school.

And importantly, these children are being denied their right to live in the “least restrictive” setting appropriate to them, a right which is guaranteed to them by Illinois law.

Beyond the negative effects on children’s lives, and the abuse of their rights, this failure by DCFS is expensive. Between 2015 and 2017, DCFS has wasted about $7M on hospitalizations that lasted longer than medically required. The alternatives, like residential treatment and foster care, are better for children AND less expensive.

However, Illinois DCFS has struggled to improve. It has gone through about 10 directors in the last 8 or 9 years, leading to haphazard policies enacted with each new crisis. In the end, it’s the children who continue to suffer.

[E]ven when there are beds available in other facilities, some of them refuse to admit children who have spent months at a psychiatric hospital—their extended stays are apparently taken as a sign that the children are particularly difficult to treat. In these cases, the longer they’re held in psychiatric hospitals, the more difficult it becomes to move them to the proper settings.

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